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April 2009

New HRSA State Health Access Program Guidance Now Available

Program guidance for the State Health Access Program (SHAP) has just been posted: or 

Public Law 111-8 has authorized $75 million for a new Federal grant program—the State Health Access Program (SHAP)—for federal fiscal year (FY) 2009 through the Health Resources and Services Administration, Healthcare Systems Bureau. SHAP grants will be awarded competitively to states that demonstrate they have a program which will expand access to affordable healthcare coverage to the uninsured populations in their state. 

Two types of grants will be available:

  • Target grants ($2 million - $4 million annually per state) for states that choose to target particular populations such as uninsured children, small business employees, or uninsured seniors; or
  • Comprehensive grants ($7 million - $10 million annually per state) for states that are planning extensive coverage initiatives.

Each grant will be awarded based on a five-year grant period, subject to the availability of funds, with funding distributed each year based on attaining benchmarks that would be designated in the grant award. HRSA will consider geographic diversity in the allocation of these awards.

The types of activities that can be supported through this grant include:

  • "three share" community coverage (employer, State or local government, and the individual);
  • reinsurance plans that subsidize a certain share of carrier losses within a certain risk corridor;
  • subsidized high-risk insurance pools;
  • health insurance premium assistance;
  • creation of a state insurance "connector" authority to develop new, less expensive, portable benefit packages for small employers and part-time and seasonal workers;
  • development of statewide or automated enrollment systems for public assistance programs; and
  • innovative strategies to insure low-income childless adults.

Criteria for selection of states:

  • States will be required to demonstrate that they have achieved the key state and local statutory or regulatory changes required to implement the new program within twelve months from the grant start date.
  • States will be required to demonstrate their seriousness of intent by matching twenty percent of the federal grant through non-federal resources, which could be a combination of state, local, and private dollars from insurers, providers, and other private organizations. Waiver of the matching requirement is possible if financial hardship is demonstrated.
  • States will be required to demonstrate their ability to sustain the program without federal funding after the end of the five-year grant period.
  • States will be required to report to HRSA the impact and results of their demonstration project at the conclusion of the five-year grant period.
  • States that have already implemented a comprehensive health insurance access expansion program are eligible to submit a proposal if it supports expansions to new segments of the uninsured, provides supplemental coverage, or is distinctive from their existing comprehensive coverage program.  Any state proposals cannot duplicate existing coverage programs. 

All questions should be directed to Michelle Herzog, State Health Access Program, at 301-443-0650 or